Healthcare Provider Details

I. General information

NPI: 1144778788
Provider Name (Legal Business Name): COLLEEN RENEE VINCENT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST SUITE 3G-16
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7243
  • Fax: 321-434-5335
Mailing address:
  • Phone: 407-303-2528
  • Fax: 407-303-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP2966222
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberARNP2966222
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN2966222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: